Officials of regional ministries of health and chief doctors in Russia will now be fined for violations when working with the Uniform State Health Information System

Main article: Digital medicine

National Information System

The Unified State Information System in the field of health care (Uniform State Health Information System) is a national information system created to provide effective information support to bodies and organizations of the health care system, as well as citizens within the framework of the processes of managing medical care and its direct receipt. The development of the system is regulated by the Concept of creating a unified state information system in the field of health care, approved by order of the Ministry of Health and Social Development of the Russian Federation of April 28, 2011 No. 364, as well as a number of methodological recommendations and functional requirements for individual components of the system that are appendices to the order.

Rostec has been identified for 2017-2018 as the sole executor of contracts for the development and support of key subsystems (Uniform State Health Information System). In particular, the corporation is working on a system for monitoring the purchase of medicines, the introduction of which is expected to save up to 50 billion rubles annually on public procurement of medicines. Rostec is also implementing a project to create a telemedicine subsystem, which, after undergoing testing at 21 medical centers in Russia, should be implemented in all regional medical institutions by the end of 2018. ​

Architecture and Infrastructure Uniform State Health Information System

The principles of building an information system are determined by the specifics of financing medical and preventive institutions. Hospitals, clinics and other medical organizations operating in the compulsory health insurance system receive the main funding from the budget of the FFOMS, which, in turn, is filled with insurance premiums deducted by employers. In order to be able to quickly monitor the activities and reporting of the LPU from the center in order to effectively spend the MHIF funds, it was decided to centralize the IT system.

The overall Uniform State Health Information System architecture consists of a centralized system-wide component segment and an application component segment.

The first, according to the concept, include subsystems for integrating application systems, maintaining a directory of system users, maintaining a register of regulatory reference information, dictionaries of medical terminology and a register of electronic documents, a subsystem for managing a certification center, operating management, email, etc. The Ministry of Health is engaged in the creation and operation of components.

The segment of applied components includes transactional (formation of primary information about the activities of medical institutions, automation of information exchange), management (integrated electronic medical record (IEMK), personalized accounting of the services provided) and reference (information support of the population, medical staff, students) subsystems.

By levels, applied information systems are divided into federal (created by the Ministry of Health) and regional. Subjects, according to the concept, must create and operate regional application systems, integrate them with federal application systems and centralized services. Treatment and preventive institutions, in turn, with the help of medical information systems implemented in themselves, must report on their own activities to the health authorities.

According to the concept, the federal data center should become the main infrastructure element of the Uniform State Health Information System. It will be based on at least three different (remote from each other) sites - the main data center, the hot standby data center (without stopping the system) and the cold standby data center (with the possibility of stopping the system). According to Roman Ivakin, director of the IT department of the Ministry of Health, the ministry abandoned the idea of ​ ​ building its own data centers and decided to rent capacity by choosing their supplier during the auction (in 2013 it is planned to spend about 1.9 billion rubles for these purposes).

The federal data center will house federal application components of the Uniform State Health Information System, centralized components at the federal level that ensure the integration of regional and institutional application systems in health care, as well as integration with the e-government infrastructure, and, finally, centralized system-wide components of a single information space in health care.

Regions can use the infrastructure of the federal data center and place their components on it or use their own (independently rented) data centers. End users (LPU employees, regional officials, etc.) will access application services through "thin clients" via the Internet (without local storage of information).

Requirements for regional GIS and MIS

Requirements for state IS in the field of healthcare of the constituent entities of the Russian Federation, medical IS, IS pharmaceutical organizations

Data sharing with private clinics

Data sharing between private health care organizations and the Unified Public System (Uniform State Health Information System) for September 2019 is one of the pressing issues of concern to the medical community. Decree of the Government of the Russian Federation No. 555 of 05.05.2018 establishes the procedure for providing data to the Uniform State Health Information System. The requirements begin to apply for all non-governmental medical organizations, including private clinics and medical centers, from January 1, 2019. However, in fact, data is not exchanged.

Resolution No. 555 prescribes to transfer a lot of types of information to the Uniform State Health Information System. First of all, among them information about the medical organization itself and doctors, as well as data on cases of medical care, including outpatient and inpatient epicrises. According to the expert, not all private organizations are ready to provide all the necessary data.

"Today, almost no one from commercial medicine is ready to provide, for example, legally significant electronic medical documents that patients require. Large network medical organizations are already preparing to carry out such an exchange, but this is associated with great costs, they are not ready to incur them now, "said Vladimir Solovyov, Development Director of Healthcare at Netrika

The problem affects both small and large geographically distributed medical organizations to the same extent. But the larger the clinic, the harder it is to meet the requirements. This is due to the need to connect each clinic, protect networks, train staff, in some cases adapt processes.

One of the ways to fulfill the requirements of the law is the use by developers of medical and laboratory information systems of an integration bus with an open API. This approach allows a private medical organization to comply with the requirements of Resolution No. 555 without significant investments in changing the IT infrastructure.

VIMIS

Within the framework of the regional project "Creating a single digital circuit in health care on the basis of a single state information system in the field of health care (Uniform State Health Information System)," a vertical integrated medical information system (VIMIS) was created. It is designed to carry out the relationship between regional health care and national medical research centers (NMICs).^[1]

In general, VIMIS is a platform solution that formulates requirements, provides information interaction with the Uniform State Health Information System subsystem, other systems, interdepartmental interaction with Ministry of Digital Development, and with the systems of federal executive bodies. To summarize, VIMIS is a clinical part of the Uniform State Health Information System, it aggregates information about both the patient and the doctor, prompts where a failure occurred in the patient's route so that medical care is provided in a timely manner.^[2]

Components of the VIMIS Platform (as of April 2023):

• VIMIS Oncology
• VIMIS Cardiovascular diseases
• VIMIS "Infectious Diseases"
• VIMIS "Preventive Medicine"
• VIMIS "Obstetrics and Gynecology" and "Neonatology"

Digital medical profile of a citizen of the Russian Federation

Main article: Digital medical profile of a citizen of the Russian Federation

Developers of the main subsystems

• Information and analytical system - "Forecast" (25 million rubles)
• Integrated EMR - Rostelecom (1 rub.)
• Centralized service for information on drug interaction - MIAC RAMS (21 million rubles)
• Electronic registration - Rostelecom (1 rub.)
• Register of regulatory reference information - "Forecast" (12.5 million rubles)
• Accounting system for administrative and economic activities - 1C-Parus (46.5 million rubles)
• Identification, authentication and authorization system - Softline-Trade (10 million rubles)

Chronicle

2024: Officials of regional ministries of health and chief doctors in Russia will now be fined for violations when working with the Uniform State Health Information System

On April 1, 2024 Russia , a law came into force, according to which officials of regional Ministry of Health and chief doctors in Russia will be fined for violations when working with Uniform State Health Information System. As reported on the website, the State Dumas state will control the entry of information on medical organizations and doctors into the Unified State Information System in the field. health care The new law will help improve the completeness and relevance of information, which ultimately should improve the quality of territorial planning in the field of health care, and ultimately - the availability of medical care, the authors of the initiative believe.

For violation of order when entering data into the Uniform State Health Information System and providing inaccurate information, fines of 10-20 thousand rubles are provided, and in case of repetitions - 20-30 thousand rubles or disqualification of those responsible for up to two years.

The law came into force, according to which officials of regional ministries of health and chief doctors in Russia will be fined for violations when working with the Uniform State Health Information System

According to the law, various data on medical workers are submitted within three working days "from the date of receipt of updated data." Basic information about the medical organization (name, address, TIN, level and type of organization, departmental affiliation, buildings, structural units, licenses, equipment, etc.) is submitted within five business days from the date of receipt of updated data from medical organizations.

According to experts interviewed by Izvestia, the innovations may lead to more attention to the reporting of doctors and medical institutions. At the same time, as noted by the head of the Higher School of Health Organization and Management Guzel Ulumbekova, this can help compile truer statistics. Incorrect data often appear in accounting systems due to the desire of regional officials to "boast of statistics" - as a result, they "draw" a sharp decrease in mortality from oncology or diseases of the circulatory system in order to fulfill the tasks of the national project "Healthcare," Ulumbekova explained.^[3]

2023

The courts began to fine private practitioners for the lack of information in the Uniform State Health Information System

At the end of January 2024, it became known that during this month the arbitration courts in Russia considered five claims for bringing private medical organizations to administrative responsibility for not bringing information to the unified state information system in the field of health care (Uniform State Health Information System). At the same time, fines began to be imposed on doctors.

We are talking about non-compliance with licensing requirements in terms of entering information into the Federal Register of Medical and Pharmaceutical Organizations (FRMO) and the Federal Register of Medical and Pharmaceutical Workers (FRMP). Claims for bringing private practitioners to administrative responsibility are mainly filed by the prosecutor's office.

It is reported that in January 2024, the Arbitration Court of the Moscow Region considered four relevant cases. In particular, Kazachinsky ophthalmologist Vladimir Vasilyevich (IP Kazachinsky V.V.), General Director of the dental clinic of Artiko LLC Galina Sergeevna Anokhina and ophthalmologist Kazachinskaya Victoria Vladimirovna (IP Kazachinskaya V.V.) were brought to justice. They did not post relevant information in the Uniform State Health Information System. In the first two cases, the court limited itself to a warning, and in the third - fined the doctor 3 thousand rubles. The fourth lawsuit was refused due to significant procedural violations committed by prosecutors during the audit.

Another case was considered in the arbitration court of the Novosibirsk region: on the claim of the territorial body of Roszdravnadzor, a warning was issued to the clinic of Alex LLC.

Taisiya Kubrina, a lawyer in the Pepeliaev Group's pharmaceutical and healthcare practice, notes that Roszdravnadzor has direct access to the Uniform State Health Information System data, and in order to establish the absence of any information in the FRMR and FRMO, the department does not need to contact the medical organization.^[4]

Petersburg will spend 426.7 million rubles on the launch of 26 subsystems for Uniform State Health Information System

On August 31, 2023, the State Order Committee St. Petersburg announced a tender for the development of the Regional Fragment of the Unified state Information System in the Field (health care Uniform State Health Information System) project in 2023-2024. The initial contract price is 426.7 million. rubles More. here

Accounts Chamber - about the problems of digitalization of healthcare: Only 22% of medical institutions transmit data to the Uniform State Health Information System

The Accounts Chamber of the Russian Federation analyzed the current state of informatization of the industry and identified a number of problems that slow down the digital transformation of this sphere. The department disclosed its conclusions at the end of August 2023. Read more here.

Putin approved fines for violation of the procedure and deadlines for submitting information to the Uniform State Health Information System

Russia Vladimir Putin The President signed a law establishing administrative responsibility for violating the procedure for submitting information to a single state information system in the field. health care The Kremlin press service announced this on July 31, 2023.

The federal law establishes administrative responsibility for violation of the procedure for submitting information to a single state information system in the field of health care. Repeated commission of this administrative offense entails stricter administrative liability.

We are talking about information about medical organizations and pharmaceutical organizations, with the exception of medical and pharmaceutical organizations subordinate to the federal executive bodies (FOIV), in which federal laws provide for military service or equivalent service, as well as organizations subordinate to the FOIV, the management of which is carried out by the President of the Russian Federation; information on persons who participate in medical and pharmaceutical activities; about persons studying in educational programs of secondary vocational and higher medical education.

Violation of the procedure and deadlines for submitting information to the Uniform State Health Information System will entail the imposition of an administrative fine in the amount of 15 thousand to 25 thousand rubles. Repeated violation - from 20 thousand to 30 thousand or disqualification for up to one year.

The history of bringing to administrative responsibility for such administrative offenses is one year from the date of their commission. The right to draw up protocols on administrative offenses is vested in officials of bodies performing functions of control and supervision in the field of health care. The law will enter into force on April 1, 2024.^[5]

Russia adopted a law on punishing officials for inaccurate statistics in the Uniform State Health Information System

In July 2023, the State Duma in the third (final) reading adopted a bill on punishing officials for inaccurate statistics in the Uniform State Health Information System. The corresponding document amends the Code of Administrative Violations (CAO).

The bill assumes that violation of the procedure for providing information to the Unified State Health Information System will entail an administrative fine in the amount of 15 thousand to 25 thousand rubles. A repeated violation will threaten with a fine of 20 thousand to 30 thousand rubles or disqualification for up to one year. The protocols will be drawn up by officials of Roszdravnadzor. The courts are empowered to consider such cases.

Personal responsibility for officials of the Ministry of Health, Department of Health and Health Committees is introduced both for inaccurate information and for disrupting the timing of data transfer to the Uniform State Health Information System.

Creation of mechanisms for monitoring the timeliness, completeness and reliability of the provision of information by state authorities of the constituent entities of the Russian Federation to the Unified System, used in the geo-information subsystem will increase the reliability of displaying information on health resources on the geo-information map and will ensure the analysis of the availability of medical care, taking into account the territorial location of units of medical organizations, types and profiles of medical care provided by them, as well as analyzing the equipment of medical organizations in order to make management decisions, - says the explanatory note to the bill.

According to the document, various data on medical workers (full name, date and place of birth, passport data, SNILS, registration, information on education, employment, etc.) will have to be transferred to the Uniform State Health Information System within three working days from the date of receipt of updated data. Basic information about the medical organization (name, address, TIN, level and type of organization, departmental affiliation, buildings, structural units, licenses, equipment, etc.) is submitted within five business days from the date of receipt of updated data from medical organizations.^[6]

The government allowed Roszdravnadzor to fine the Ministry of Health of the regions for failure to provide data to the Uniform State Health Information System

The government considered and approved a bill according to which Roszdravnadzor will be able to fine the Ministry of Health of the regions for failure to provide data to the Uniform State Health Information System. This was reported in the cambin on May 29, 2023.

The bill also gives Roszdravnadzor the authority to control how quickly and reliably state authorities and medical organizations submit data to the Uniform State Health Information System, Vladimir Gruzdev, chairman of the board of the Russian Bar Association, a member of the legal commission, told Izvestia.

The unified system provides citizens with online access to medical services, and also shows information on health resources on the geo-information map. The system operates, for example, registers of medical documents on birth and death, on medical examination for the right to own weapons. There is also a register of children with rare diseases. The system should also receive data on specialized and high-tech medical care for the population. And this is not the entire range of tasks of this service, so it is extremely important that the system contains up-to-date data, "he explained.

As follows from the document, Roszdravnadzor will be able to check the completeness, reliability and relevance of the information on medical organizations and specialists who participate in the implementation of medical activities, as well as the timing of the submission of information, entered into the Uniform State Health Information System by the health management bodies of the subjects. Fines will be provided for violation of order and inaccurate data.

The Ministry of Health of the Russian Federation believes that the regional authorities do not fully provide information to the Uniform State Health Information System, from which the geo-information subsystem automatically collects and displays on the geo-information map information about healthcare resources - about the medical organization, its buildings, structural divisions, staffing, equipment, licenses for medical activities, etc.^[7]

Military registration and enlistment offices in Russia will have access to an electronic medical record of conscripts

Military commissariats will have access to the Unified Information System in the Field health care (Uniform State Health Information System), which contains data, in particular, on conscripts. The corresponding amendments to the provision on the conscription of Russians for service have been made Ministry of Defense of the Russian federation to the draft government decree. This became known in early May 2023.

According to Kommersant, the authors of the document propose to use data from the Unified System to form electronic personal files of conscripts and send applications for the allocation of specialist doctors for examinations. It is emphasized that the innovation will minimize the number of errors and speed up the process of medical examination. Municipal commissariats are supposed to report on the results of the examination of conscripts to the regional military commissar, and that to the head of the region.

The legislation in force by May 2023 provides for the resolution of the issue of a citizen's suitability for military service on the basis of a medical examination sheet and a conscript's medical examination card.

State Duma Deputy Alexander Borodai stressed that this is a technical issue that does not contain a political context. The parliamentarian added that military registration and enlistment offices need to provide all the necessary information.

In an interview with the newspaper, Vadim Tkachenko, a lawyer, founder and CEO of the vvCube consulting group, noted that according to the law, only those persons who were given permission by the patient have access to medical data. At the same time, any information of this nature can be disclosed in the interests of the state at the request of government agencies or the court.

Now medical organizations may be obliged to disclose information without the consent of patients at the legislative level - this is what the project is talking about, the expert is sure.^[8]

2022

A third of regions of the Russian Federation did not provide data in Uniform State Health Information System

In 2022, approximately one in three Russian regions did not provide data to the Unified State Health Information System (Uniform State Health Information System). This became known in early June 2023.

At the same time, it became known about the decision of the Ministry of Health to introduce fines for the lack of such information for the heads of subjects. The Uniform State Health Information System project provides for the unification of all medical organizations in Russia into a single information network, as well as the creation of a database of all medical workers. In addition, classifiers and reference books of medical services should be formed. At the same time, certain medical services are provided to citizens in electronic form. These are, in particular, the federal electronic registry and an integrated electronic medical record with information on all diagnoses, care provided and medical certificates.

For the correct operation of the geoinformation map of Russian health care, the regions must provide data on medical institutions and doctors. However, according to the Kommersant newspaper, in 2022 such information was not received from 36 constituent entities of the Russian Federation: they include the Moscow region, Crimea, Karelia, Yamalo-Nenets Autonomous Okrug, etc. In order to correct the situation, the Ministry of Health has developed draft amendments to the Administrative Code on the relevant fines for the heads of regions. It is assumed that the amount of penalties will be from 15 thousand to 25 thousand rubles. In case of a repeated violation, the guilty person will have to pay up to 30 thousand rubles; in addition, he may be disqualified for a period of one to two years.

At the same time, the regional authorities say that the difficulties with the transfer of data to the Uniform State Health Information System are explained by objective reasons. This, for example, the lack of integration with a single state information system, as well as the peculiarities of the regional digital circuit.^[9]

The Ministry of Health transfers the state register of drugs to the Uniform State Health Information System for 190 million rubles

In November 2022, the Ministry of Health of the Russian Federation announced a tender for the transfer of the State Register of Medicines (GRLS) to the platform of the Unified State Information System in the field of healthcare (Uniform State Health Information System). The department is ready to pay up to 189.8 million rubles for this project. The contractor will be selected by November 11, 2022. Read more here.

The Ministry of Health will pay 100 million rubles for visualization and data analytics in a single IT healthcare system

In September 2022, the Ministry of Health of the Russian Federation launched a tender for the development of a subsystem for automated collection of information on health system indicators from various sources and reporting, the development of subsystems of the Unified State Information System in the field of health care (Uniform State Health Information System). We are talking about a contract worth almost 100 million rubles.

According to the terms of the state order, its executor will have to create a component for monitoring and managing infrastructure projects (KMUIP) within the framework of federal projects and programs in the field of health care, providing, in particular, visualization and automated analytical data processing. In addition, it will be necessary to integrate the Federal Register of Medical Organizations with KMUIP in order to avoid double entry of information and the geoinformation subsystem of the Uniform State Health Information System for visualizing information on the implementation of measures of sectoral federal projects and programs on the geographical map. KMUIP will allow assessing the current and planned state of the healthcare infrastructure, according to the tender materials.

The draft law "On the federal budget for 2023 and the planning period 2024-2025" allocated 185 billion rubles to finance the departmental project "Creation and development of information systems in healthcare," including 11.5 billion rubles for the creation of a single digital circuit based on Uniform State Health Information System. In 2022, 157.1 billion rubles were planned for these purposes.

By October 2022, Russia plans to link regional hospitals and clinics into a single information system. This means that institutions will have to almost completely switch to electronic document management, and all information about the patient will be available to doctors even if a person changes the hospital, clinic and even the region.^[10]

Rostelecom has been selected as the only integrator of GIS OMS and Uniform State Health Information System

In September 2022, Prime Minister Mikhail Mishustin signed a decree that approved the sole executor of the contract for the integration of GIS compulsory medical insurance and Uniform State Health Information System. Read more here.

Russia adopted a law on the creation of a register of pharmaceutical workers

In July 2022 State Duma , it adopted amendments to Federal Law No. 323, which approved the creation of registers of pharmaceutical workers and pharmaceutical companies, as well as a register of persons studying at medical universities. All these lists will be integrated with the Unified state Information System (health care Unified Information System). More. here

Roszdravnadzor will be fined for late entry of data into the Uniform State Health Information System

Roszdravnadzor will be fined for late entry of data into the Unified State Information System in the field of health care (Uniform State Health Information System). The corresponding bill, developed by the Ministry of Health of the Russian Federation and presented at the end of June 2022, will enter into force on September 1, 2022.

According to the document, officials of executive authorities in the regions will be fined for incomplete, unreliable or untimely provision of data to the Uniform State Health Information System. The amount of the fine will be from 15 thousand to 25 thousand rubles. For repeated commission of an administrative offense, they will already be fined from 20 thousand to 30 thousand rubles or disqualified for a period of one to two years.

As noted in the explanatory note to the bill, the regions "do not fully" ensure the transfer of information to the Federal Register of Medical Organizations of the Uniform State Health Information System, from which the geo-information subsystem automatically generates a map with information about healthcare resources in each region, the level and type of medical organization. This information is needed by the Ministry of Health "for the purposes of rational territorial planning in the field of health," according to the document.

The Ministry of Health previously stated that medical organizations, especially private ones, do not fill the Uniform State Health Information System with up-to-date information. This negatively affects the operation of the geo-information system and support for management decisions. At the same time, the current legislation does not allow influencing the timing and procedure for entering information.

In June 2022, the Ministry of Health proposed to entrust the verification of the entry of data into the Uniform State Health Information System to Roszdravnadzor. The corresponding amendments are proposed to be made to Art. 88 and 91 of the Federal Law No. 323 of the 21.11.2011 "On the basics of protecting the health of citizens." It is assumed that both bills will come into force on September 1, 2022^[11]

The results of the medical examination of drivers will be entered in the register of the Uniform State Health Information System

The results of the medical examination of drivers will be entered into the register of the Unified State Information System in the field of health care (Uniform State Health Information System) for timely updating of data on their health status. This is stated in the bill, which the Government of the Russian Federation submitted to the State Duma in June 2022.

By this time, the legislation establishes the obligation for drivers to undergo a medical examination of vehicle drivers when the 10-year validity period of the driver's license expires, however, the lack of interdepartmental information interaction between the Ministry of Health of Russia and the Ministry of Internal Affairs of the Russian Federation on the exchange of information leads to the fact that drivers who have identified medical contraindications continue to drive vehicles until the expiration of the driver's license.

So, if the driver of the vehicle is identified during a medical examination or examination, the information will be recorded in the Uniform State Health Information System, and the driver will be sent for an extraordinary mandatory medical examination. If the driver is confirmed to have contraindications to driving a vehicle, the previously issued medical report is canceled, and information about this is posted in the register. At the same time, a new medical report will be issued.

In addition, the detected contraindications to driving a vehicle will be the basis for invalidating a driver's license. The deadline for the entry into force of the bill is set from March 1, 2023.

By June 23, 2022, the State Duma is also considering a bill on the possibility of conducting remote medical examinations of drivers before and after the flight.^[12]

The government agreed on the connection of the traffic police to medical bases

In early June 2022, it became known that the Government Commission on Legislative Activities approved the draft amendments to the law "On Road Safety," according to which the traffic police will be connected to medical bases and will be able to receive data on the health of drivers. It is assumed that data exchange will be established through the state information system in the field of health care (Uniform State Health Information System).

The fact that the government approved a requirement according to which doctors will be obliged to send data on the health of drivers to the traffic police, writes Kommersant with reference to the Russian Bar Association. Information about drivers who have diseases in which it is impossible to drive a car will come to the traffic police directly from medical organizations. This will make it possible to establish an information exchange between medical institutions and the State Traffic Inspectorate, which will make it possible to quickly remove from driving cars persons who, for health reasons, have no right to drive.

By the beginning of June 2022, non-professional drivers are required to undergo a medical examination once every ten years, when their certificates expire. The exchange of data between doctors and the traffic police will make the roads safer, the head of the Union of Driving Schools of Russia Alexander Achkasov is sure.

There will already be a full exchange of these certificates, and we will understand that a person does not need to be driving at all, it will be great, everyone will benefit from this. I myself had a case when in one of the chain stores a person was bad, there was an attack of epilepsy - in such cases he must have a note somewhere to call his relatives - and I saw his rights. A person with such a diagnosis should not be driving, and he came to the store by car, "he explained.

Under the new law, the traffic police will be able to automatically deprive drivers with medical contraindications. If the car owner is diagnosed with diseases with which it is forbidden to go on the road, the inspectors will quickly see this in the database and temporarily cancel the certificate. And the driver will be sent for an extraordinary inspection. And if the diagnosis is confirmed, then he will be prohibited from driving.^[13]

Mishustin approved the modernization of the Uniform State Health Information System. It will connect all regional medical organizations

The Prime Minister Mikhail Mishustin signed a decree approving the modernization of the Unified state Information System in the Field (health care Uniform State Health Information System). The press service of the Cabinet of Ministers announced this on February 11, 2022.

The planned update of the Uniform State Health Information System assumes that the system will connect all regional medical organizations. At the same time, most documents - extracts, certificates and medical records should go into electronic form. Doctors will have access to the necessary documents, for example, to the medical history, even if a person moved and changed the clinic or hospital, the Government of the Russian Federation said.

All information will be collected in one place. This is much more convenient. And in an emergency, this can save a person's life, - said Mikhail Mishustin at a meeting of the Presidium of the Coordination Council under the Government of the Russian Federation to combat the spread of the new coronavirus (COVID-19) infection on February 8, 2022.

As part of the modernization of the Uniform State Health Information System, a separate element of the system will be an information resource for recording information to prevent outbreaks of the coronavirus pandemic. The Cabinet of Ministers expects that the analysis of these data will make it possible to predict the situation and promptly take measures.

The updated Uniform State Health Information System will include various federal registries, including databases of medical documents on death and birth, as well as information on the results of medical examinations for the right to own weapons. In addition, the system will provide data on the drug provision of citizens.

On March 1, 2022, a decree of the Government of the Russian Federation will also come into force, which determines the route of an electronic death certificate from a medical organization to the Uniform State Health Information System and regulates the exchange of necessary information between federal departments. For users of the Gosulug portal, an electronic document on the death of a loved one will be available from October 2022.^[14]

The developer " Medlock" through the court demanded that the Ministry of Health connect it to the Uniform State Health Information System

In February 2022, the developer of the Medlock IT system through the court demanded that the Ministry of Health of the Russian Federation be connected to the Uniform State Health Information System. We are talking about the Medrating company, which filed a lawsuit with the Moscow Arbitration Court, demanding that the department's refusal be declared illegal. Read more here.

2021

"Tsifromed" became the only executor of contracts of the Ministry of Health and FMBA for the development of Uniform State Health Information System

"Tsifromed" became the only executor of contracts of the Ministry of Health and FMBA for the development of Uniform State Health Information System. The corresponding government order in October 2021 was signed by Prime Minister Mikhail Mishustin.

In accordance with the document, the company until the end of 2022 will solely ensure the purchase of goods, works and services related to the creation, development, implementation and operation of Uniform State Health Information System subsystems, as well as technologies and platform solutions to ensure communication with them regional industry InformSystems.

The only executor of public procurement for the unified departmental medical information and analytical system of the FMBA of Russia "Tsifromed" will remain until December 31, 2021. The Federal Center for Information Technologies of Extreme Problems and the Center for Strategic Planning and Management of Biomedical Health Risks will cooperate with the company for public procurement.

By the end of 2022, Tsifromed will implement state contracts for the creation of Uniform State Health Information System in seven organizations of the Ministry of Health, among them - the Federal State Budgetary Institution  TsNIIIZ of the Ministry of Health of Russia, national medical research centers - named after V.A. Almazov, oncology named after N.N. Blokhin, named after Academician V.I. Kulakov, therapy and preventive medicine, phthisiopulmonology and infectious diseases and St. Petersburg Petersburg Pediatric Medical University University.

The government also provides one of the conditions for choosing Tsifromeda as the sole executor of orders for the development of the Uniform State Health Information System in the organizations of the Ministry of Health and the FMBA - the company will have to use radioelectronic products and software of domestic origin as a priority. In addition, Tsifromed will be able to involve subcontractors, provided that it performs at least 20% of the work on its own.

Order of the Government of the Russian Federation No. 2957-r dated 20.10.2021

Connecting Death and Birth Document Registries

On September 7, 2021, it became known about the decision of the Ministry of Health to include registers of medical documents on birth and death in the Unified State Information System in the Field of Health (Uniform State Health Information System). The department wants to automate the procedure, which has always been under the jurisdiction of the registry office.

About the new initiative of the Ministry of Health write Sheets"" with reference to the draft government decree prepared by the ministry. The head, Competence Center for Digital Transformation of the Health Sector of the Ministry of Mikhail Levin having familiarized himself with the document, explained to the publication that medical organizations, which record, in particular, the facts of death, will directly enter data into the Uniform State Health Information System in electronic form. Then, from this system, information will go to the Unified State Register of Civil Status Records (USR Registry Office), and then to. Rosstat

By September 2021, medical organizations, in the event of a person's death, issue a paper certificate to his relatives, which must be taken to the registry office. After that, the data is transmitted to the USR registry office, and based on the information received by the system, Rosstat collects statistics on death.

Even in those regions where there is already an electronic extract of documents on birth or death, certificates are printed, and the representative of the born or deceased is obliged to carry them to the registry office, says Alla Ivanova, head of the health and self-preservation behavior department of the Institute for Socio-Political Studies of the Federal Research Sociological Center of the Russian Academy of Sciences. Already in the registry office, the operator is typing data into the register office system, as a result of which errors appear due to inattention and other factors, she explained. When the system starts working, the intermediary will be eliminated, who transfers data from the paper certificate to the Unified State Register registry office, Alla Ivanova believes.

The new draft resolution, among other things, proposes to include a drug circulation subsystem in the Uniform State Health Information System. It will include the state register of drugs, the register of maximum selling prices of manufacturers for drugs included in the list of vital and essential drugs, the register of permits for clinical trials of drugs, etc.^[15]

Mishustin charged to the Ministry of Health and the Ministry of Digital Development to upgrade Uniform State Health Information System

In July 2021, Mikhail Mishustin instructed the Ministry of Health of the Russian Federation and the Ministry of Digital Development of the Russian Federation to modernize the Unified State Information System in the field of health care (Uniform State Health Information System). According to the head of government, the refinement of the GIS is important, since it provides simplified access for citizens to medical services, is responsible for the interaction of all information systems in the field of health care.

According to the press service of the cambin, the ministries will have to develop technical solutions that will stabilize the operation of the system taking into account the increased load. Starting July 12, 2021, they will report to the government every week on the work and availability of the federal segment of the Uniform State Health Information System, including the federal electronic registry, the register of patients with coronavirus, and the register of vaccinated citizens.

The next stage - until July 19, 2021, the Ministry of Health and the Ministry of Digital Development must submit proposals for the inclusion in the electronic government infrastructure of subsystems of the federal segment of the Uniform State Health Information System, providing services on a single portal of public services.

By September 1, 2021, the Ministry of Health and Ministry of Digital Development must submit proposals for the creation of a single digital platform based on the Uniform State Health Information System and the GosTech platform. Thus, it is planned to carry out a comprehensive digitalization of processes that are related to the provision of medical care.

From October 1, 2021, a mechanism for confirming the accreditation of doctors and pharmacists will be introduced in the Unified State Health Information System - they will no longer need to wait for a paper document, for the manufacture of which up to 30 days. It will be enough for health workers to make a mark on accreditation in the Uniform State Health Information System. The previous certificate will be issued only at the request of the specialist.^[16]

NCI creates AI diagnosis system for integration with Uniform State Health Information System

On April 21, 2021, it became known that the National Center for Informatization (NCI) had created a technological system for making a medical diagnosis and prescribing treatment using machine learning and artificial intelligence algorithms . Read more here.

Mishustin allocated 210.5 million rubles for the development of Uniform State Health Information System

Prime Minister Mikhail Mishustin signed a decree on the allocation of about 210.5 million rubles from the reserve fund for the development of the Unified State Information System in the field of health care (Uniform State Health Information System). The press service of the Cabinet of Ministers announced this on April 16, 2021.

The allocated funds will be used to pay for government contracts in the field of information and communication technologies, which were concluded in 2020 for the development of Uniform State Health Information System subsystems. Contracts must be completed by June 1, 2021. It is assumed that a new stage in the development of Uniform State Health Information System will help speed up the transfer of public services to electronic form and provide them on the principle of digital super services.

The Uniform State Health Information System will include 13 subsystems, including federal registers of medical professionals and organizations, an electronic registry, and an integrated electronic medical record. In addition, it will include subsystems for monitoring the organization of the provision of high-tech medical care and sanatorium-resort treatment, as well as monitoring and control in the field of public procurement of medicines. The work is carried out within the framework of the national project "Health."

It is assumed that by 2024 a system of electronic prescriptions and automated management of preferential drug provision will work throughout Russia. On the portal of public services in any region, it will be possible to sign up for medical examination, apply for a policy, open the necessary medical documents. All this will simplify the receipt of services for citizens, and for doctors it will reduce the paper load.

The total cost of creating Uniform State Health Information System by April 2021 exceeded 40 billion rubles, and the project has not yet been completed. Earlier, the Ministry of Finance of the Russian Federation reported that the budget of the federal project "Creation of a single digital circuit in healthcare on the basis of a single state health information system (Uniform State Health Information System)" by the end of 2020 was executed by 57.5%.^[17]

The Ministry of Health allowed medical institutions not to duplicate documents in paper form

On January 12, 2021, the Ministry of Justice of Russia registered an order of the Ministry of Health "On approval of the procedure for organizing a document management system in the field of health protection in terms of maintaining medical documentation in the form of electronic documents." Thanks to this document, which comes into force on February 1, health workers will no longer need to duplicate the primary medical documentation on paper.

It is assumed that the rejection of mandatory paper documents will relieve health workers from bureaucratic work and give them the opportunity to devote more time to their direct duties to patients.

At the same time, medical institutions have the right to decide for themselves whether to switch to electronic document management in whole or in part. They also independently establish the timing of such a transition and the types of papers that will be digitized.

According to the deputy minister, the health care Russia Pavel Pugachev document enshrines legal status, electronic document management allowing medical organizations to report to control and supervisory authorities in digital format.

This order is a key document for the industry that will allow medical organizations to move from paper to electronic. Until today, there was a problem. For the second year we have been living in a federal project to create a single digital circuit, and the digitalization process itself has been going on even longer - since the early 2000s. And we were still obliged to keep all medical documentation in paper form, "he said.

The order of the Ministry of Health also establishes requirements for the formation, signing and storage of electronic medical documents. Such a document can differ from the approved format only if this prevents its correct display. In addition, he must have an electronic signature.^[18]

2020

Mishustin allowed the use of impersonal medical data to train AI systems

In December 2020, Prime Minister Mikhail Mishustin signed a government decree "On Amendments to the Regulation on a Unified State Information System in the Field of Health," supplementing the subsystem of the Federal Integrated Electronic Medical Record Uniform State Health Information System with functionality for storing sets of impersonal medical data.

With this document, the Cabinet of Ministers allowed the use of impersonal medical data in order to create algorithms and methods of machine learning in order to form systems for supporting medical decision-making, creating and applying technological decisions based on artificial intelligence.

This government decree updates the regulation on the Uniform State Health Information System and defines the following functions of the system:

• storing sets of impersonal medical data for their use in order to create algorithms and methods of machine learning in order to form systems for supporting medical decision-making, creating and applying technological solutions based on artificial intelligence;
• support for markup, preparation of sets of impersonal medical data, their verification for solving a specific problem, including using machine learning methods;
• support the development of technological solutions based on artificial intelligence;
• storage, functioning, verification of technological solutions based on artificial intelligence;
• access of medical organizations to technological solutions based on artificial intelligence.

Earlier in 2020, the Ministry of Economic Development proposed to simplify the mechanism for transmitting medical data protected by medical secrecy, in particular, information about a citizen's request for medical care, his state of health and diagnosis - software developers to create products using artificial intelligence and big data technologies.^[19]"

From January 1, medical certificates in Russia will be issued in electronic form

From January 1, 2020, medical certificates and conclusions in Russia will be issued in electronic form along with paper media. This is stated in the order of the Ministry of Health of the Russian Federation, registered with the Ministry of Justice in early December 2020. Read more here.

The Ministry of Health of the Russian Federation allowed the use of data from the Uniform State Health Information System for training artificial intelligence

As it became known in November 2020, the Ministry of Health of the Russian Federation allowed the use of impersonal medical data from the Uniform State Health Information System for training artificial intelligence. The corresponding document is published on the federal portal of draft regulations.

We are talking about expanding the functionality of the subsystem "Federal Integrated Electronic Medical Record" - about the preparation and storage of sets of impersonal medical data. 

The Ministry of Health intends to support marking, the preparation of sets of impersonal medical data, their verification to solve a specific problem, including using machine learning methods; support the development of technological solutions based on AI. In addition, medical organizations will have access to AI-based technology solutions.

According to the national strategy for the development of artificial intelligence for the period up to 2030, creating conditions that will ensure the use of artificial intelligence technologies in the field of health is one of the key tasks to improve the standard of living of the population. According to the Ministry of Health of the Russian Federation, confidence in medical intelligent systems and barriers related to the use of AI systems in medical diagnostics can be removed by standardizing the requirements for testing methods for intelligent systems, as well as criteria for compliance of these systems with safety requirements.^[20]

By 2024, at least 50% of state and municipal medical organizations will have to use products and services using artificial intelligence technologies, the introduction of which will begin next year, the Ministry of Health told Rossiyskaya Gazeta. A roadmap has been approved providing for a plan to transfer budget health care to work with artificial intelligence.

Mishustin allocated another 900 million rubles for the development of Uniform State Health Information System

On November 10, 2020, the Government of the Russian Federation announced the allocation of another 898 million rubles from its reserve fund for the development of the Unified State Information System in the field of health care (Uniform State Health Information System). The corresponding order was signed by Prime Minister Mikhail Mishustin.

According to the press service of the Cabinet, Uniform State Health Information System is part of a large-scale project to create a single digital circuit in health care, which will bring the provision of services in the field of health care to a fundamentally new level.

By 2024, a system of electronic prescriptions and automated management of preferential drug provision will work throughout Russia. In your personal account on the portal of public services, you can sign up for a doctor and medical examination.

It is noted that the Uniform State Health Information System will include 13 subsystems, including the federal register of health workers and the federal register of electronic medical documents. It will also include subsystems for monitoring the organization of high-tech medical care and spa treatment.

This will help speed up the transfer of public services important for citizens to electronic form and provide them on the principle of digital superservices, the press service said.

This initiative is being implemented within the framework of the Digital Economy national project. In total, it is planned to allocate more than 1.8 trillion rubles for its implementation. Funds for the development of an information system in the field of health care are also planned to be directed to the Digital Region federal project of the Digital Economy national project.

The total cost of creating Uniform State Health Information System by November 9, 2020 amounted to more than 40 billion rubles, but so far the project has not been completed. In July 2020, the Russian government already allocated additional funds in the amount of 300 million rubles to "complete previously concluded contracts in 14 regions to create a single digital circuit in healthcare."^[21]

The portal Infoklinia.Ru is included in the register "Other Information Systems" as part of the Uniform State Health Information System

On November 3, 2020, it became known that the portal was Infoclinica.RU officially included in the register "Other Information Systems" as part of the Unified state Information System (health care Uniform State Health Information System). This status allows you to centrally connect the portal to the Uniform State Health Information System, as well as UIAS to the unified system and. authentications authorizations More. here

The Ministry of Health of the Russian Federation creates a unified register of births and deaths based on Uniform State Health Information System

In October 2020, the Ministry of Health of the Russian Federation began creating a register of births and deaths on the basis of a unified state information system in the field of health care (Uniform State Health Information System). A notice of the development of the relevant bill has been published on the federal portal of draft regulatory legal acts.

According to these materials, within the framework of the Uniform State Health Information System, the federal register of registration of information about birth and the register of data on mortality of citizens will be formed and filled out. The purpose of such changes is a better analysis of statistics on deaths and births, including accounting for encodings for various causes of death of a person.

If such information interaction is established, it will not only increase the quality of statistical data, but also save polyclinic employees from the need to go to territorial registry offices with notebooks and manually check their information about the attached population with their data, the head physician of one of the treated and preventive institutions told Medvestnik on condition of anonymity. This will allow doctors to devote more time to direct duties, he added.

It is assumed that the amendments will enter into force in May 2021, and the transition period for the new system of accounting for deaths and births will be six months.

In October 2020, the Ministry of Health of the Russian Federation announced an experiment to synchronize the collected data on mortality, including from a new coronavirus infection, in the republics of Bashkortostan, Dagestan and the Moscow region. At the same time, other Russian subjects will be able to join it - for this they need to send an application to the Ministry of Health. The purpose of this experiment in the department called improving the quality of official data on mortality of the population.^[22][23]"

Putin instructed to expand the number of services for communication between a doctor and a patient at the EPGU

In August 2020, the president Russia Vladimir Putin gave several instructions following a meeting on the readiness of the system health care for the autumn-winter epidemic season. One of the instructions concerns an increase in the number of services for communication between a doctor and a patient on. public services

The head of state instructed the executive authorities to expand "the use of modern electronic technologies in the field of health care for remote interaction between a doctor and a patient, including through the portal of state and municipal services, in order to prevent the spread of respiratory infections and the prevention of infectious diseases in citizens during the autumn-winter epidemic season of 2020-2021, "according to the Kremlin website.

In addition, the executive authorities of the constituent entities of the Russian Federation are recommended to ensure the organization of medical examination and vaccination campaign against influenza for the population free of charge and without queue, approving the appropriate schedules and creating conditions for remote recording of citizens, as well as, if necessary, their delivery to the place of medical examination and/or vaccination.

The Government of the Russian Federation must provide reports on this and other instructions to the President by September 25, 2020.

By August 2020, the following health services are available to Russians on the public services portal:

• calling a doctor at home;
• an appointment with the doctor at the clinic;
• providing access to electronic medical documents.^[24]

Residents of Moscow and the Moscow region can also use a number of additional services related to the healthcare sector on the regional portal of public services. For example, you can check how much preferential medicines cost in pharmacies in the region or clarify the time of arrival of an ambulance. How to check your insurance status through an online resource, find the pharmacy closest to home, find out full information about donation

Rostec will connect FMBA of Russia to Uniform State Health Information System

Rostec and the Federal Biomedical Agency signed an agreement on the construction of a single digital circuit of the FMBA of Russia on the basis of the Unified State Information System in the Field of Health (Uniform State Health Information System). The project will be implemented by the National Center for Informatization (NCI, part of the Rostec State Corporation). Rostec announced this on July 29, 2020. Read more here.

The Ministry of Health of the Russian Federation allowed medical institutions to completely switch to electronic document management

At the end of July 2020, the Ministry of Health of the Russian Federation submitted an order "On approval of the procedure for organizing a document management system in the field of health protection in terms of maintaining medical documentation in the form of electronic documents." With this document, the department allows medical institutions to completely switch to electronic document management.

If the medical organization makes a decision to maintain medical documentation in the form of electronic medical documents in full or in part, the act of the head of the medical organization approves the rules for maintaining document management in the medical organization in terms of medical documentation in the form of electronic medical documents, the text of the order says.

In accordance with the order, access to electronic medical documents is provided to citizens through the Unified Portal of State and Municipal Services using the Unified State Information System in the Field of Health (Uniform State Health Information System), as well as through the information systems specified in Parts 1 and 5 of Article 91 of Federal Law No. 323 "On the Basics of Health Protection."

As a member of the Expert Council of the Ministry of Health on the use of information and communication technologies in the health care system and a member of the working group on the preparation of the draft order, Alexander Gusev, told Medvestnik, the discussion of the document was "hot." Some experts participating in the discussion expressed radically opposite opinions, as a result of which they had to conduct a substantive dialogue, select arguments "for" and "against" various provisions. As a result, on most controversial issues, it was possible either to come to a consensus, or to find a compromise solution, he added.

Earlier, the deputy head of the Ministry of Health Pavel Pugachev called the refusal of paper a priority task of informatization of the healthcare industry.^[25]

The Ministry of Health will introduce fines for failure to provide information about medical institutions to the Uniform State Health Information System

On June 10, 2020, it became known about the decision of the Ministry of Health of the Russian Federation to introduce fines for failure to provide information about medical institutions to the Unified State Information System in the Field of Health (Uniform State Health Information System). Violators - officials of executive authorities in the constituent entities of the regions - will be charged from 10 to 20 thousand rubles, and in case of a repeated case - up to 30 thousand rubles, according to the bill developed by the department (published on the federal portal of regulatory legal acts).

The document supplements Part 6 of the Code of Administrative Offenses of the Russian Federation with Article 6.39, which provides for penalties for state authorities and medical organizations for failure to submit, incomplete submission or for submitting irrelevant information to the Uniform State Health Information System.

Protocols on administrative offenses will be drawn up by employees of Roszdravnadzor. In addition to fines, disqualification of officials for a period of one to two years will be introduced.

As noted in the explanatory note to the bill, the regions "do not fully" ensure the transfer of information to the Federal Register of Medical Organizations of the Uniform State Health Information System, from which the geo-information subsystem automatically generates a map with information about healthcare resources in each region, the level of the medical organization, the type of organization. 

This information is needed by the Ministry of Health "for the purposes of rational territorial planning in the field of health," according to the document.

Earlier, after the onset of the coronavirus pandemic COVID-19 Ministry of Health , he called on medical institutions to urgently update or enter information in the federal register of the Uniform State Health Information System.

Deputy Minister of  Health Pavel Pugachev called the lack of responsibility of medical organizations for the failure to provide data to the Uniform State Health Information System "a big problem."^[26] 

2019

Rostec remained the only provider of services for the construction of Uniform State Health Information System

In November 2019, the Prime Minister Dmitry Medvedev signed a decree that made "" Rostec the only provider of services for the construction of a Unified state Information System in the field (health care Uniform State Health Information System). The monopoly status of the state corporation will remain until the end of 2020.

As follows from the order of the Government of the Russian Federation No. 2719-r dated November 16, 2019 , Rostec was chosen as the sole executor of the purchases of goods, works and services carried out by the Ministry of Health of Russia in 2019-2020 related to the creation of centralized digital technologies and platform solutions to ensure the interaction of state information systems in the field of health care of the constituent entities of the Russian Federation and the unified state information system in the field of health care.

Rostec may attract subcontractors and co-contractors, provided that the state corporation personally fulfills at least 1% of the total value of obligations under state contracts.

Previously, Rostec developed Uniform State Health Information System together with Rostelecom and the Voskhod Research Institute: the latter were engaged in the development of a regional network, and the state corporation was engaged in interaction with the federal system.

According to the Vademec portal, by mid-November 2019, the cost of creating Uniform State Health Information System amounted to more than 40 billion rubles, but it was not possible to complete the construction of the system. Earlier, the Accounts Chamber reported that the Ministry of Communications and Rostelecom delayed the connection of hospitals to the Internet, and the Ministry of Health did not have time to form a regulatory framework for the Uniform State Health Information System within the planned period.^[27]

The Ministry of Health has been managing the creation of a unified health information system in the Russian Federation since 2011. In part, the Uniform State Health Information System consists of several sections covering various branches of the provision of medical services: electronic medical records, online appointment with doctors, separate patient registries with information about diagnoses, data on prescribed and purchased (including personal) medicines and the provision of high-tech assistance.

The option "just ask" appeared in the electronic queue system in polyclinics in Russia

On September 19, 2019, it became known that the "just ask" option appeared in the electronic queue system of the Kaliningrad polyclinic of the City Hospital No. 3. Read more here.

Platform Registration N3.Health

On June 4, 2019, it became known that the service N3.Health developed by the company Netrika"" was registered in the Unified state Information System in the Field (health care Uniform State Health Information System). Developers for ON commercial medical organizations have the opportunity to establish an exchange data with the Federal Integrated Electronic Medical Record (IEMK). Thanks to this, private clinics and medical holdings will be able to fulfill the requirement to transfer information on the provision of services to patients at IEMK, which is contained in Resolution No. 555 Governments of the Russian Federation of May 5, 2018. Read more. here

Citizens' access to electronic medical documents in the Personal Account "My Health" on the portal of public services

In 2024, all state municipal medical organizations will provide citizens with access to electronic medical documents in the My Health Personal Account on the portal. public services This was announced on May 22, 2019 by the company. In NCI 2019, the share of such organizations will be 4%, and in 2020 - 20%. These indicators, announced, will be achieved within the framework of the Federal Project "Creating a Single Digital Circuit Based on health care ," UNIFORM STATE HEALTH INFORMATION SYSTEM implemented Ministry of Health Russia by the National Center for Informatization (part Concern Automatics of the State Corporation). Rostec

The NCI has developed the subsystem "Federal Register of Electronic Medical Documents" (hereinafter referred to as the RMP), which is part of the Uniform State Health Information System. The subsystem organizes the collection of information from information systems in the field of healthcare about electronic medical documents created in medical organizations. Its goal is to provide citizens with electronic medical organizations through the portal of public services, ensure interdepartmental electronic interaction and create conditions for the transition of medical organizations from paper medical document management to legally significant electronic medical document management.

The transition to a legally significant electronic document flow in healthcare expands the possibilities of using interdepartmental electronic interaction, allowing you to set and solve problems for simplifying the actions of state bodies in the event of certain life situations. Thus, one of the closest results of the transition to a legally significant electronic document flow in healthcare should be simplified procedures for citizens to obtain a driver's license, register the facts of birth and death, and establish a disability group.

Legally significant electronic document management in healthcare will eliminate the possibility of loss or distortion of medical documentation. Conditions will be created for medical organizations and doctors to gain access to all the patient's medical documentation, which will improve continuity of care, which is one of the main priorities of national health along with disease prevention, and, as a result, will affect the recovery time of patients.

Elena Boyko stated:

{{quote 'author = 'Elena Boyko, Deputy Minister of Health of the Russian Federation. '| One of the main tasks of the federal project "Creating a single digital health care circuit" is to build the work of medical information systems at the regional level, complete their integration with the subsystems of the Uniform State Health Information System. When moving to another city or region, a person will be able to access his medical documents through his personal account on the website of public services (EPGU). In May 2019, this opportunity is not available to all citizens, for this it is necessary that medical organizations are connected to a single digital circuit, begin to create medical documents in digital format, store them and register (transmit links about their presence) in the federal system. The ability of each citizen to access their electronic medical documents should be ensured by the end of 2024. }}

Since the beginning of 2019, the constituent entities of the Russian Federation began to actively connect to the RAMD subsystem, as of the beginning of May 2019, more than a third (32) of the constituent entities of the Russian Federation began to transfer information about electronic medical documents to the subsystem. In the period from February to April 2019, over 190 thousand legally significant electronic medical documents were registered, formed in more than 200 state medical organizations of the Russian Federation. In May 2019, in the Personal Account "My Health" of the portal of public services for residents of pilot regions (Krasnodar Territory, Tula and Belgorod Regions, the Republic of North Ossetia - Alania), a service for gaining access to electronic medical documents will be available, which will allow citizens to view their medical documents, as well as manage their availability for medical workers.

Deputy Minister of Health Elena Boyko - on the further development of the Uniform State Health Information System

In May 2019, Deputy Minister of Health Elena Boyko, in an interview with TAdviser Editor-in-Chief Alexander Levashov, spoke about the main directions of the digital development of health care and the role of the Uniform State Health Information System in it. Read more here.

The role of Uniform State Health Information System in the digitalization of Russian healthcare (click to increase)

2018

Allocation of 63 billion rubles for the creation of regional segments of Uniform State Health Information System

On November 23, 2018, information appeared that the State Duma adopted the federal budget of the Russian Federation for 2019 and for the planning period 2020 and 2021. in the final, third reading. According to the official website of the State Duma for the implementation of regional projects "Creating a single digital health care circuit based on the Unified State Information System in the Field of Health (Uniform State Health Information System)," the constituent entities of the Russian Federation will receive more than 63 billion rubles over the next three years, 11.9 billion of which are planned to be paid in 2019.

The largest amounts will be directed to the Republic of Bashkortostan (2.4 billion rubles), Krasnodar Territory (2.3 billion rubles) and the Moscow Region (2.2 billion rubles). The Sakhalin Region will receive the least money for the implementation of the project (44.2 million rubles), the Electronic State Expert Center said.

	Amount of subsidies (thousand rubles)
Name of the subject of the Russian Federation	2019	2020	2021
Republic of Adygea (Adygea)	52 513,0	177 308,0	49 584,0
Republic Altai	56 380,0	190 365,0	53 235,0
Republic of Bashkortostan	462 662,0	1 562 173,0	436 858,6
Republic of Buryatia	115 748,0	390 822,0	109 293,0
Republic of Dagestan	366 354,0	1 236 991,0	345 922,5
Republic of Ingushetia	86 488,0	292 027,0	81 665,0
Kabardino-Balkar Republic	134 217,0	453 183,0	126 732,1
Republic of Kalmykia	62 437,0	210 819,0	58 955,1
Karachay-Cherkess Republic	85 562,0	288 898,0	80 789,8
Republic of Karelia	101 279,0	341 967,0	95 630,8
Republic Komi	96 620,0	326 235,0	91 229,9
Republic of Crimea	211 232,0	713 222,0	199 450,1
Republic of Mari El	97 203,0	328 206,0	91 781,7
Republic of Mordovia	87 024,0	293 836,0	82 170,0
Republic of Sakha (Yakutia)	163 995,0	553 726,0	154 847,8
Republic of North Ossetia - Alania	110 493,0	373 078,0	104 330,0
Republic Of Tatarstan (Tatarstan)	126 938,0	428 604,0	119 858,0
Republic of Tuva	83 736,0	282 734,0	79 065,8
Udmurt Republic	154 960,0	523 219,0	146 316,5
Republic of Khakassia	40 970,0	138 335,0	38 685,0
Chechen Republic	141 839,0	478 917,0	133 927,1
Chuvash Republic - Chuvashia	166 848,0	563 361,0	157 542,7
Altai Territory	178 525,0	602 788,0	168 568,3
Trans-Baikal Territory	132 385,0	446 995,0	125 000,7
Kamchatka Territory	55 414,0	187 103,0	52 323,0
Krasnodar Territory	434 506,0	1 467 105,0	410 272,6
Krasnoyarsk Territory	235 172,0	794 055,0	222 055,3
Perm Territory	208 929,0	705 447,0	197 277,3
Primorsky Territory	149 678,0	505 387,0	141 331,2
Stavropol Territory	279 560,0	943 933,0	263 968,6
Khabarovsk Territory	127 970,0	432 090,0	120 833,2
Amur Region	102 410,0	345 787,0	96 698,4
Arkhangelsk region	148 268,0	500 626,0	139 999,3
Astrakhan region	72 512,0	244 836,0	68 468,0
Belgorod region	144 631,0	488 345,0	136 563,8
Bryansk region	151 876,0	512 806,0	143 405,0
Vladimir region	111 618,0	376 879,0	105 393,3
Volgograd region	111 699,0	377 151,0	105 470,0
Vologda Oblast	116 104,0	392 025,0	109 628,5
Voronezh region	246 141,0	831 092,0	232 413,1
Ivanovo region	97 530,0	329 309,0	92 091,0
Irkutsk region	220 624,0	744 935,0	208 319,4
Kaliningrad region	88 461,0	298 686,0	83 526,3
Kaluga region	83 103,0	280 596,0	78 468,0
Kemerovo region	245 440,0	828 724,0	231 750,8
Kirov region	54 222,0	183 080,0	51 198,0
Kostroma region	42 109,0	142 181,0	39 760,0
Kurgan region	84 669,0	285 884,0	79 947,0
Kursk region	102 420,0	345 821,0	96 709,0
Leningrad Oblast	75 365,0	233 484,8	71 161,4
Lipetsk region	106 761,0	360 477,0	100 806,4
Magadan region	52 491,0	177 236,0	49 563,2
Moscow region	428 420,0	1 446 556,0	404 526,2
Murmansk region	73 282,0	247 436,0	69 195,5
Nizhny Novgorod region	267 934,0	904 677,0	252 990,4
Novgorod region	71 716,0	242 148,0	67 716,0
Novosibirsk region	246 645,0	832 795,0	232 888,6
Omsk region	215 219,0	726 684,0	203 214,9
Orenburg region	200 331,0	676 414,0	189 157,5
Oryol region	115 507,0	390 008,0	109 064,5
Penza region	77 852,0	262 867,0	73 511,0
Pskov region	90 323,0	304 976,0	85 286,1
Rostov region	384 605,0	1 298 613,0	363 154,3
Ryazan region	120 005,0	405 195,0	113 312,0
Samara region	222 029,0	749 680,0	209 646,2
Saratov region	232 068,0	783 576,0	219 126,0
Sakhalin Oblast	8 317,0	28 081,0	7 852,0
Sverdlovsk region	313 101,0	1 057 181,0	295 637,9
Smolensk region	105 356,0	355 734,0	99 480,9
Tambov region	73 498,0	248 164,0	69 398,0
Tver region	128 183,0	432 809,0	121 033,5
Tomsk region	112 372,0	379 423,0	106 105,1
Tula region	120 268,0	406 084,0	113 559,7
Tyumen region	50 401,0	170 179,0	47 590,0
Ulyanovsk region	139 742,0	471 839,0	131 948,5
Chelyabinsk region	290 378,0	980 459,0	274 183,8
Yaroslavl region	110 514,0	373 148,0	104 350,1
City of Federal Significance Saint Petersburg	249 515,0	767 954,9	235 599,8
city of federal significance Sevastopol	33 668,0	113 681,0	31 791,0
Jewish Autonomous Region	49 878,0	168 412,0	47 095,2
Nenets Autonomous Okrug	15 405,0	52 016,0	14 546,5
Khanty-Mansiysk Autonomous Okrug - Ugra	12 901,0	43 558,0	12 181,0
Chukotka Autonomous Okrug	33 542,0	113 256,0	31 672,0
Yamal-Nenets Autonomous Okrug	16 469,5	16 469,5	16 469,5
In total	11 875 535,50	39 962 963,20	11 214 124,30

Source: E-State Expert Center

In July 2018 Government of the Russian Federation , she gave instructions To the Ministry of Health on the national project "Healthcare" following a meeting of the Presidium of the Presidential Council for of the Russian Federation Strategic Development and Priority Projects. Among other things, it was envisaged to create a single digital circuit in health care based on Uniform State Health Information System. The project involves the extension of the Uniform State Health Information System to the regions.^[28]

In general, within the framework of the national project "Healthcare" by 2022, full-fledged InformSystems should appear in all 85 regions of Russia, to which all local medical organizations will be connected. This was announced in July 2018 by the head of the Ministry of Health Veronika Skvortsova. At the same time, digital medicine was presented by it as one of the eight sub-projects of the mentioned interdepartmental national project.^[29]

More than half of medical institutions in Russia issue electronic sick leave

By the end of November 2018, more than half of medical institutions in Russia provide electronic sick leave along with traditional paper. Read more here.

Formation of Russian telemedicine infrastructure based on Uniform State Health Information System

On National Center for Informatization Rostec Ministry of Health Russia November 20, 2018, the State Corporation and the All-Russian Center for Disaster Medicine "Zashchita" announced the signing of a cooperation agreement. The first joint project of the parties will be the completion of the formation of the Russian telemedicine infrastructure. By the end of 2018, it is planned to connect more than 700 medical institutions in all regions of the country to the telemedicine system. Remote communication of experts from national centers and practitioners from regional clinics will take place through the Unified State Information System (health care Uniform State Health Information System). More. here

Putin approved the executors of the project for the development of a unified IT health care system

On November 19, 2018, it became known that the president Russia Vladimir Putin approved the proposal of the state corporation Rostec to make it, as well as Rostelecom the research institute "Sunrise" , the main executors of the state order for the development of a unified state health information system (Uniform State Health Information System).

According to Kommersant, Rostelecom and Voskhod will deal with regional subsystems, and Rostec will coordinate their pairing with the Uniform State Health Information System core. To minimize the risks of poor-quality development of regional systems, Rostec proposes to transfer government orders to the same contractors for the development of all regional components of the Uniform State Health Information System.

According to the 2017 budget, the cost of Uniform State Health Information System for 2018-2019 will amount to 1.45 billion rubles. According to the publication in the Ministry of Health, by November 2018, it is impossible to clarify the amount of costs for the creation and connection of regional subsystems that Rostec will deal with, since the relevant documents "are being approved."

The Ministry of Health also refutes the decision to choose the only executors of the state order - presumably because it has not yet been formalized by the relevant government order.^[30]

All antimonopoly experts referred to by Kommersant agree that the selection of the only suppliers according to the decisions of the president or government significantly distorts the picture of competition in the sectors of the economy - more than a quarter of all government orders were spent on such purchases in some years, and we are talking, as a rule, about the most expensive projects.

At a meeting with members of the Federation Council, Minister of Health of the Russian Federation Veronika Skvortsova said that medical organizations should be connected to the Uniform State Health Information System by the end of 2021. She noted that medical information systems must meet unified requirements, "which allow integrating these information systems into single hubs, information nodes." 

BARS Group organizes the exchange of disability certificates between the RMIS and the FSS in electronic form

Director for Territorial Development of BARS Group, a subsidiary of the National Center for Informatization (part of the Rostec Group of Companies), Alyokhin Vladimir spoke in February 2018 about the current status of the project and the prospects for the development of the regional segment of the Unified State Information System for Health Care (Uniform State Health Information System) in the Saratov Region as part of the seminar "Electronic Disability Certificate. Information interaction of the Social Insurance Fund (FSS) with medical organizations "with the participation of the Chairman of the FSS of the Russian Federation Andrei Kigim.

Since July 1, 2017, an electronic sick leave has been introduced throughout Russia. In accordance with Federal Law No. 86-FZ, at the request of the insured person (employee), when applying to a medical organization, he can be issued a certificate of incapacity for work (sick leave) in electronic format. By the beginning of March 2018, the number of electronic disability lists issued in Russia reached more than 500,000.

Electronic sick leave is formed in the automated system of the Social Insurance Fund of the Russian Federation, doctors put an electronic signature and send it to the Fund. An employee of the organization no longer has to take the sheet to the human resources department, and a doctor with such a scheme can devote more time to the patient.

"In the spring of 2018, our contractor will organize the exchange of sick leave certificates issued to the MIS with the database of the Social Insurance Fund in electronic form," comments Vladimir Shuldyakov, Minister of Health of the Saratov Region.

The creation of the regional segment of the Uniform State Health Information System of the Saratov region is today one of the flagship regional projects of BARS Group. More than 150 medical organizations of the region work in the medical information system (MIS) of the company's development, more than 15 thousand workplaces are automated. In 2018, in all 9 regions in which MIS BARS Group operates, a similar exchange of electronic sick leave will be provided.

2017

Using blockchain

In September 2017, it became known about the plans of the Ministry of Health of the Russian Federation to transfer electronic patient cards in Russian medical institutions to a blockchain-based system. Citizens will be able to independently choose with whom they will share personal information. The head of the department Veronika Skvortsova spoke about this at the Eastern Economic Forum (Vladivostok, September 6-7).

It will be depersonalized, which will allow this data to be kept completely safe. The key will be individualized, - said Skvortsova.

According to her, people will have a choice with whom to share their medical information, which will be associated with the choice of the medical organization and the attending physician.^[31]

In the blockchain system of electronic medical records, each patient will receive his own digital key to access personal information that will not be in the public domain. The Ministry of Health believes that this approach will help preserve medical secrecy.

At the end of July 2017, the president Russia Vladimir Putin signed a law on development information technology in health care. Its essence is the formation of a single state information system based on the implementation of an electronic integrated medical record. The same law spelled out norms for telemedicine and cross-document management. The decision, which has been worked out over the past two years together with the presidential administration, boils down to the fact that the system will be arranged on the principle of blockchain.

Rostec and the Ministry of Health will jointly develop Uniform State Health Information System

The Ministry of Health of the Russian Federation and the state corporation Rostec agreed on cooperation in the framework of the Digital Health development projects in Russia. On September 15, 2017, the cooperation agreement was signed by Minister of Health Veronika Skvortsova and General Director of Rostec State Corporation Sergey Chemezov at the Biotechmed forum.

The agreement provides for a partnership in the field of information and telecommunications technologies, including the following:

• joint work of the parties to develop the Unified State Information System in the field of health care (Uniform State Health Information System) and create a unified technological platform for digital health care on its basis;
• the development of electronic medical document management systems and the introduction of uniform standards for information exchange in this area;
• promoting the transfer of domestic advanced solutions to wide clinical practice - we are talking, in particular, about the introduction of technologies for remote medical monitoring of the patient's health and information systems for supporting medical decision-making.

According to Veronika Skvortsova, the Electronic project health care is aimed at improving the quality and availability of medical services. The automation of management and the introduction of modern diagnostic and treatment technologies make it possible to make the work of healthcare institutions more transparent and operational, increase the throughput of institutions, bring medicine closer to the person, reduce the time between the correct diagnosis and the appointment of the necessary treatment.

For his part, Sergei Chemezov noted that the Russian Ministry of Health, together with industry, is doing a lot of work to bring domestic medicine to the next level of development. To this end, an information and analytical system for monitoring the purchase of drugs is being introduced, a segment of the telemedicine subsystem is being created, to which all medical institutions in the regions will be connected by the end of 2018.

More than 6.5 thousand medical organizations are connected to the Uniform State Health Information System

September 14, 2017 during a press conference "Digital health care in Russia. The beginning of the new time "within the framework of Biotechmed 2017, Director-at-Large of Rostec State Corporation, Chairman of the Board of Directors of the National Center for Informatization (NCI) Vasily Brovko announced the interim results of the project for the development and support of the Unified State Information System in the field of health care (Uniform State Health Information System), carried out by the NCI on behalf of Rostec by order of the Ministry of Health of Russia, and spoke about the prospects for further implementation of the system.

According to him, as of mid-2017, more than 6,500 medical organizations are already connected to the system and information on more than 1.5 million medical workers is being processed. With the help of the Federal Electronic Registry, more than 7 million applications for medical appointments are registered monthly.

We expect that the number of citizens using the personal account of the patient "My Health" on the Unified Portal of State Municipal Services will grow to 48 million people by 2025. The telemedicine market may show explosive growth in the commercial segment. In 2018, every fifth constituent entity of the Russian Federation will organize medical care using telemedicine, - said Vasily Brovko.

As an example of the synergy of high-tech companies within the Rostec State Corporation in the interests of the development of digital healthcare, Vasily Brovko cited the example of the Obstetrics and Neonatology software and hardware complex, a joint product of the Shvabe concern and BARS Group (a subsidiary of NCI) in the field of telemedicine.

The confirmed effect of using the delivery system has already been recorded in the Nizhny Novgorod region: over 2 years, the maternal mortality rate in the region has decreased by 50%. By the way, according to the Program for the Development of Perinatal Centers in the Russian Federation, Rostec is a customer for the construction of 15 such centers, "said Vasily Brovko.

The curator of Rostec's distressed assets headed the Uniform State Health Information System analysis group

As it became known to TAdviser, in March 2017, a working group was created in the Rostec state corporation to analyze the documentation, state contracts and reporting documents of the Uniform State Health Information System, as well as the technological analysis of its subsystems.

The group will act as Rostec's project office for managing informatization projects in the field. health care

Alexander Nazarov became the head of the working group, in February 2017 he was appointed deputy general director of Rostec. In the state corporation, Nazarov oversees the management of non-core and problematic assets, as well as the creation of unified information systems.

RT-Design Technologies is directly responsible for managing distressed assets at Rostec, whose CEO Sergei Yarosh, according to TAdviser, also joined the working group.

Rostec explained the participation of RT-Design Technologies in the working group by the fact that this company is developing an information and analytical system for analyzing drug prices.

On the part of the "National Center for Informatization" - the developer of the main subsystems of the Uniform State Health Information System - the general director Konstantin Solodukhin will participate in the working group. On the part of the Ministry of Health - the head of the IT department Elena Boyko and her deputy.

Tasks of the working group:

1. Conducting a documentary analysis of regulatory, design, working, operational documentation, state contracts for development and operation, reporting documents on them for the following subsystems of Uniform State Health Information System and data processing centers:

a. federal electronic registry;

b. integrated electronic health record;

c. systems for maintaining specialized patient registers for individual nosologies and categories of citizens;

d. the main data center of the Uniform State Health Information System (DPC);

e. Uniform State Health Information System Backup Data Center (RDC)

f. test site Uniform State Health Information System.

2. Development of a program for process analysis of these subsystems, DPC, DPC, Uniform State Health Information System test site based on the study of the above documents

3. Process analysis of the specified subsystems EGISZ, OCOD, RDPC, test site Uniform State Health Information System.

4. Preparation of a report on the results of the documentary and technological analysis of the Uniform State Health Information System components listed in item 1 of this List.

5. Performing the functions of the project office of the Corporation for the management of informatization projects in the field of health care.

Uniform State Health Information System is developing as a multi-component system, in the creation and development of which various teams participate, developing new functionality that provide technical support to the existing one, "Elena Boyko told TAdviser. - We believe that coordinating the work of these teams by creating a working group, a project office is the right solution. The Ministry of Health, of course, will support organizational measures that are aimed at improving the efficiency and quality of the work performed

Putin urged to rid hospitals of nerves, queues and paper

At a meeting of the Council for Strategic Development and Priority Projects in March 2017, President Vladimir Putin boasted of achievements in the field of health care in recent years in the form of increasing the life expectancy of the population and reducing mortality and announced the need to create "a truly modern health care system." It is necessary for the situation to continue to develop in the key necessary for the state, he said.

According to the president, it is necessary to build a system that meets the highest world standards at all levels: from primary care to federal clinics. Informatization is one of the mechanisms for solving a number of existing problems, such difficulties with writing to the right specialist and quickly passing examinations.

I again draw attention to the fact that it is necessary not only to provide clinics and hospitals with the Internet, but to ensure that citizens get an appointment and are examined without nerves and queues, including the elderly, who do not always understand such concepts as "information technology" and "electronic record," the head of state said. - And doctors would get rid of unnecessary paperwork and more time could devote to the patient, continuously improve their qualifications, online seek advice from colleagues from regional and federal centers.

Putin also noted that it is necessary to look at the long term, use the potential of domestic science and achieve breakthrough results in the field of genetics, personal and biomedicine, processing big data, and ensure the practical application of advanced developments at all levels of health care.

Health Minister Veronika Skvortsova said at the meeting that, together with the constituent entities of the Russian Federation, in 2018, the formation of a three-level regional health care system will be completed on the basis of uniform requirements for the placement of medical infrastructure with a specially created geo-information system.

In 2019, the formation of a system of telemedicine consultations between medical organizations of various levels, including national, scientific, practical and medical centers, will be completed in general, "Skvortsova said.

From 2020, according to her, electronic monitoring of the health of patients from risk groups will be gradually introduced using individual devices that measure pressure, pulse, concentration of glucose and other elements in the blood, position in space, and so on, with the inclusion of an emergency response system when these parameters change to critical values.

In 2014-2016, together with the expert professional community, the National Medical Chamber created a system of national clinical recommendations for major human diseases. According to the Minister of Health, in order to accelerate the adaptation of doctors to them, in December 2016, the creation of an electronic rubricator of clinical recommendations and a fast search engine for diagnostic and treatment algorithms by keywords and graphological structures was completed.

This system begins to be introduced everywhere this year through the automated workplaces of doctors, of which now 70 percent of the required number. By the end of 2018, clinical guidelines will be implemented in all regions of the country. Based on clinical recommendations, criteria for assessing the quality of medical care, enshrined in regulations, have been developed. From July of this year, all expert control measures will be carried out with their use, the minister reported.

The priority of extreme importance is the development and introduction of new digital and biomedical technologies, Veronika Skvortsova noted. In 2020, the formation of a unified state information system for the health sector on the basis of a single electronic medical record of the patient will be completed as a whole, she promised.

This will allow the introduction of cross-electronic document management and the patient's personal account. From any computer, each person will be able to enter his personal account and receive the necessary information, extracts from medical documents, make an appointment with a doctor, contact an insurance representative, the Minister of Health explained.

The system will create an archive of digital images and implement intelligent automated image reading programs with a sharp increase in the accuracy and timeliness of diagnostics. A system of automated examination of the quality of medical care will be introduced: comparison of the management algorithm of a particular patient with the reference protocols and quality criteria sewn into the system.

Skvortsova said that by the end of 2020, the system will be fully integrated with information and analytical systems of compulsory medical insurance, circulation of drugs and medical devices, which will allow a comprehensive analysis of the resource efficiency of the entire industry.

Thus, by the end of 2020, we will be able to reach a qualitatively new level of health care management, as well as continuity and quality of care. It is planned that from 2020, automated programs for processing large amounts of BIG DATA data will begin to be introduced, which will allow you to automatically select the optimal algorithms for medical support for each person, taking into account telemedicine consultations, the minister is sure.

In 2016, the creation of the National Register of Physicians and the Unified Portal for Continuous Physician Development, which reflect the individual trajectory of each physician's professional development, were also completed. All doctors in the country will enter this system by the end of 2021.

2016

Experience in informatization of health care in the Kirov region

Implementation of the roadmap for the development of reg. The Uniform State Health Information System segment of the Kirov region in 2015-2018 in terms of the main measures is characterized by the following indicators:

• 95% of divisions of medical organizations and all pharmacy organizations are connected via secure communication channels to the regional information resource
• 70% of doctors and nurses work in the medical information system
• 87% of outpatient units provide the opportunity to make an appointment with a doctor or study through the Unified Portal of Public Services and the official website of the Ministry of Health of the Kirov Region
• The appointment schedules of 57% of doctors are transferred to the subsystem of the federal electronic registry of the Uniform State Health Information System
• The medical information system of the Ministry of Health maintains electronic medical records (EMR) for 88% of patients insured in the compulsory medical insurance system
• Data contained in electronic medical records are transferred from the medical information system to the regional integrated electronic medical record (IEMC) system
• The Unified Dispatch Ambulance and Emergency Medical Service has introduced an automated system that receives calls from the population of the entire region.

See more about the project here.

Medvedev launched a new stage of total informatization of health care. Only did not give money

In November 2016, the Russian government declared health informatization one of the priority projects, described its goals and fixed a budget that turned out to be very modest (for more details, see a separate article).

Online health. What will be the unified information space of health care in Russia?

After analyzing the trends in the application of information technology in health [1] care, TAdviser and the National Center for Informatization prepared an infographic and an overview of the prospects for creating a single eHealth space and considered it from the standpoint of the patient, doctor and regulators of the industry.

Click to enlarge Click to enlarge

Skvortsova following a meeting with Medvedev: IT is one of the 5 main priorities for the development of health care

On August 31, 2016, the head of the Ministry of Health of the RFVeronika Skvortsova announced that IT would become one of the main directions for the development of health care in the country. She spoke about this at a meeting of the Presidium of the Presidential Council for Strategic Development and Priority Projects.

Five areas were allocated that will be concentrated over the next two to three years, since it is during their implementation that we plan to achieve new positive indicators in improving the quality, availability of medical care, in improving demography, "Skvortsova said at a meeting with Prime Minister Dmitry Medvedev.

Among these areas was the development of the Unified State Information System in the field of health care (Uniform State Health Information System) in order to improve electronic document management. All medical state and municipal organizations will be gradually connected to this system, thanks to which it will be possible to introduce electronic document management not only within individual institutions, but also between them.

The head of the Ministry of Health also spoke about plans to form a personal account of the patient "My Health" on the portal of public services. There, Russians will be able to learn the possibilities of obtaining medical care, make an appointment with a doctor, call a doctor at home, access their own medical documents and assess the level of medical services. This project is being implemented jointly with the Ministry of Telecom and Mass Communications.

As part of the development of digital technologies in Russian medicine, it is also planned to connect automated doctor's jobs to a single information system in several years. This will reduce the written work of doctors and free up at least 30% of working time for direct interaction with patients.

This will allow unlimited access to all information bases, to the electronic medical library, to decision-making assistance systems and, in addition, to the possibility of telemedicine consultations with relevant organizations - regional, federal - the necessary profile, - said Veronika Skvortsova.

In addition to IT, the key areas of health care development included a decrease in maternal and infant mortality, an increase in the availability of medical care in the regions of the Russian Federation, an increase in the quality of training of doctors and the introduction of a new level of control over public procurement of drugs and the transition to reference pricing.^[32]

2015: Uniform State Health Information System Roadmap to 2018

At the end of April 2015 , the Ministry of Health published^[33] Draft Roadmap for the Development of the Uniform State Health Information System in 2015-2018. The document spells out the deadlines and benchmarks for various areas, such as infrastructure and applied support for the development of the Uniform State Health Information System, organizational and regulatory support.

In terms of application support, for example, it is planned that in 2015, 20% of medical organizations in the constituent entities of the Russian Federation should transfer information from electronic medical records of patients to the subsystem of the electronic medical record of the federal segment of the Uniform State Health Information System. In 2016, this figure should be 30%, and in 2018 - 80%.

According to the draft roadmap, in 2015, 25% of doctors in the regions must submit information on the appointment schedule to the subsystem of the federal electronic registry of the Uniform State Health Information System. In 2016, the percentage of those should be 40%, and in 2018 - 80%.

The document also prescribes that in 2016 all regional medical information systems of the constituent entities of the Russian Federation must comply with the requirements approved by the Ministry of Health. At the same time, 30% of medical organizations should use such systems in 2016, 50% in 2017, and 100% of medical organizations in 2018.

In the direction of infrastructure, one of the benchmarks is the percentage of medical organizations connected to the components of the regional segment of the Uniform State Health Information System. In 2015, 50% of organizations should be connected, and in 2017, an indicator of 100% should be reached.

Another indicator in the infrastructure direction is the percentage of AWS of medical personnel connected to regional or institutional medical information systems. In 2015, there should be 20% of them, in 2016 - 50%, and 100% are planned to be released in 2018.

2014: Rostec, Rostelecom and Voskhod appointed sole executors of Uniform State Health Information System

Since January 2014, the Government Russia has appointed the only executors for health informatization projects. The Government RostecRostelecom Research Institute "Sunrise" Dmitry Medvedev^[34] as the^[34]

The appointment of the only performers was initiated by Minister of Health Veronika Skvortsova and Minister of Communications Nikolai Nikiforov, writing a letter to President Vladimir Putin, who, in turn, supported the idea.

The company's sole executor status allows the state customer to conclude contracts with it without conducting competitive procedures. For example, Rostelecom has had this status in relation to electronic government for several years.

With Rostec, the Ministry of Health has signed contracts to support the already developed federal electronic registration services and an integrated electronic medical record (collects and processes data from electronic records from all regions). In addition, the state corporation received an order to provide a test data center.

Voskhod provides the Ministry of Health with the services of the main data processing center, and Rostelecom provides a backup data center.

Coup in Rostec

Until May 2014, Rostec's subcontractor under the project of the Ministry of Health was Regionkom, in which the state corporation was a minority shareholder.

Since the end of May, Rostec has entrusted the project to a 100% subsidiary - RT-Electronic Services (later renamed the National Center for Informatization),^[35] a stake in Regionkom^[35].

2013: MTS DPC Lease

In June 2013, the Ministry of Health held an electronic auction to select a contractor who will lease the data center and communication channels to him to ensure the operation of the Uniform State Health Information System. The initial auction price was 1.738 billion rubles. The term for the provision of capacities is until the end of 2013. The winner was MTS, which agreed to provide services for 564.9 million rubles.

The data center, which was rented by the Ministry of Health, housed the federal applied components of the Uniform State Health Information System:

• services "Integrated electronic medical record" (aggregates data from electronic medical records from all over the country) and "Electronic registration,"
• management accounting system for administrative and economic activities of medical organizations,
• register of regulatory reference information,
• identification service and analytical system.

Preparations for the auction were accompanied by scandals. The Ministry of Communications and Senator Ruslan Gattarov opposed his announcement In a fierce ^[36]

2012

Competition 16 Medical System Developers

One of the basic principles of the creation of Uniform State Health Information System, spelled out in its concept, is to ensure competition among manufacturers of medical information systems, systems that automate administrative and economic activities, and other specialized systems.

At the beginning of 2012, before tenders for basic informatization began to start en masse in the regions, Deputy Minister Andrei Guselnikov even spoke about this. He warned the subjects against carrying out complex purchases to create Uniform State Health Information System segments, including at the same time the construction of data centers and SCS, and equipping medical institutions with computer equipment, and the development and implementation of MIS. Such tenders significantly reduced the chances of victory for specialized independent developers and, on the contrary, increased the chances of large integrators.

"We

will not only monitor such purchases separately at the federal level, but also study them for competitiveness and efficiency, consulting with specialists from the FAS and the Accounts Chamber," Guselnikov warned.

But the main part of the tenders started after he left the Ministry of Health.

At the beginning of 2012, according to the Association for the Development of Medical Information Technologies (ARMIT), 128 developments were present in the healthcare automation market of the Russian Federation, which the developers attributed to the class of medical information systems. In fact, only 62 systems are such, said Alexander Gusev, Deputy Director for Development of KIIS:

"Among them, 23 systems are active market participants, to which we include companies with stable development dynamics and at least a minimum sufficient amount of real implementations."

As a result of tenders for regional fragments of the Uniform State Health Information System, according to Gusev's estimates, only 16 decisions were eventually able to withstand competition and participate in the implementation of at least one such project. Companies that managed to replicate their decisions in two or more regions made up an even narrower group - their number was limited to 12 firms.

"Probably, the further development of competition and leading positions in the market will be concentrated precisely between these companies," Gusev concludes.

The fashion for comprehensive purchases, according to the KIIS representative, covered about 50% of Russian regions. In about half of them, a new player in the market for informatization of medicine, Rostelecom, won. Medical software was directly introduced in the regions by the subcontractors of the operator - Bars Group and KIR.

"Almost all contests were launched a few months before the end of 2012, and Rostelecom skillfully used its administrative resource to convince officials that if they take a decision from Rostelecom, they will not have problems with the implementation of projects in such a time frame," confirms Andrei Borisov from the PMT

.

Rostelecom does not agree with this assessment of its success.

"The fact that our decision is chosen by the regions indicates its demand and effectiveness," says Roman Kravtsov, acting vice president of the operator for innovative development.

Health informatization, according to Kravtsov, is one of the priority innovative services of Rostelecom: "We offer an integrated approach to health informatization based on our cloud platform. O7 Such a solution allows the customer to quickly receive the service without significant investment in equipment. "

In the largest customer of Rostelecom for the informatization of health care - the Committee for Informatization and Communications of St. Petersburg, which signed a contract with the operator for the supply of a hardware and software complex for automating the system of the regional fragment of Uniform State Health Information System for 848 million rubles, we are satisfied with the contractor.

"All obligations of Rostelecom as a general contractor under various state contracts have always been fulfilled on time and in full," committee head Ivan Gromov told CNews.

Another new name in the market for informatization of medical institutions can be considered the state corporation "Rostec," which also took quite strong positions at the regional level. In 2011, Rostec acquired the Perm developer MIS - the company "Swan." In addition, market participants consider RusBI-Tech to be close to Rostec.

The state corporation not only won a number of tenders for the creation of fragments of Uniform State Health Information System, but also conducts construction of federal perinatal centers and centers of high-tech medical services throughout the country, where it also has the opportunity to implement its software. According to the results of basic informatization, the PMT (since 2011 it has been part of the Armada Group of Companies) managed to gain a foothold in seven regions. According to the Ministry of Health, three regions each have SofTrust, KIIS and Smart Delta Systems.

For the MIS market, the past 2 years are likely to lead to a noticeable stratification of developers, said Alexander Gusev from KIIS:

"Those companies that managed to gain a foothold in the market by participating in regional competitions received the necessary" financial feed "and a certain field for the development of products and implementations. The same companies that were localized in one or two regions that could not take part in the implementation of informatization programs are currently in the zone of increased risks, since new mass purchases or a complete redistribution of regions in terms of choosing MIS are unlikely to be expected in the next 2-3 years. "

Market participants and experts assessed the results of the basic informatization stage in general in different ways.

"Of course, many computers have been installed and many local networks have been laid, but how reasonably this is used is a big question," says ARMIT President Mikhail Elyanov. - Where there are competent specialists, the efficiency of using the funds received is higher, where there are none (and the vast majority of such places) - much lower. There have been no big problems with personnel resources and accounting software before, it seems to me; and I do not think that the modernization of health care was started precisely for the sake of these services. I think that more or less full-fledged MISs are installed in several percent or even tenths of percent of LPUs. "

It is impossible to say that no actions have been made on the part of the state regarding the creation of conditions for informatization, adds Alexander Gusev.

"At the same time, the analysis of the situation raises certain doubts that the funds spent on informatization will bring them an adequate result for practical healthcare (the most ordinary doctors, nurses and ordinary medical institutions)," he said. "In a number of regions, such a result has really been achieved, but, unfortunately, not everywhere and not to the full extent."

MIS connection to the Internet

The introduction of MIS went in parallel with the construction of data centers, the supply of equipment, the construction of communication channels, says Andrei Borisov, General Director of the PMT) (developer of MIS "Medialog"): "Of course, it could not be different, given the timing, but the task of implementation made it much more difficult."

Summing up the results of the "basic informatization," Roman Ivakin noted that it was possible to ensure "a fairly high level of infrastructure development."

"As for the connection of the LPU to the Internet, according to our data, this task is 100% completed at the level of legal entities. Perhaps their local units, for example, FAPs, remained partially unattached. But do not forget that there are more than 40 thousand such facilities, and the connection work actually began only in June 2012. For comparison: it took about 1.5 years to connect 52 thousand schools to the network. "

The policy of the Ministry of Health restrains informatization

In February 2012, Andrei Guselnikov, Deputy Minister for IT, was appointed to the Ministry of Health. He promised to strictly control regional purchases and asked the subjects not to rush to hold tenders for the introduction of MIS, explaining this by the need to complete pilot projects. The regions took under the visor, but suspended not only the purchase of specialized software, but also any informatization in general.

"Pilots" also did not go smoothly everywhere. In March 2012, Ivanovo Region and the Republic of Sakha (Yakutia) were excluded from the pilot regions for failure to meet deadlines and passive position. Deputy Minister Guselnikov threatened the responsible vice-governors with sanctions.

In this regard, or not - it is not known, but since June 2012, the deputy chairman of the government of the Ivanovo region, Vladimir Gerasimchuk, who led the government apparatus, has been transferred as the plenipotentiary representative of the governor to the Ivanovo Regional Duma.

Guselnikov himself also left his post in June 2012, explaining this by the reorganization of the ministry (the Ministry of Health and Social Development was divided into the Ministry of Health and the Ministry of Labor, Veronika Skvortsova became the Minister of Health instead of Tatyana Golikova). Soon the director of the IT department Vadim Dubinin (who replaced Oleg Simakov) also left the ministry, his deputy Roman Ivakin became his successor.

"In fact, informatization activities began in the vast majority of subjects only in June 2012," Ivakin admits.

2011

Slipping of basic informatization of LPU

The first stage of the creation of Uniform State Health Information System - "basic informatization" - according to the plan was to start in 2011 and be completed at the end of 2012. During this time, in more than 40 thousand hospitals and clinics (8.4 thousand legal entities) throughout the country, it was necessary to conduct the Internet (if it was not there), install computers (in order to save money, it is recommended to use free software on them), introduce medical information systems (MIS), organize data exchange between LPU and health authorities. In terms of one legal entity, each of the LPU out of the total amount of 20.2 billion rubles. got an average of 2.4 million rubles.

Having completed the basic informatization, medical institutions had to gain access to federal services and keep a personalized record of the medical care provided in electronic form, manage mutual accounts for the assistance provided, analyze activities and generate reports, and keep records of administrative and economic activities. In addition, all LPUs had to earn electronic registration services, appointments for a doctor's appointment and issuing referrals via the Internet. It was not possible to meet the schedule.

As of May 2013, about half of the LPUs at the legal entity level joined the services of the electronic registration, appointment and issuance of directions, according to the ministry.

"Basically, a

decrease in the total indicator was observed due to the electronic registration, the rest of the functions are in almost all organizations," explains Roman Safronov, deputy director of the IT department of the Ministry of Health.

The process of informatization in the subjects was slow, periodically interrupted. Throughout 2011, for example, regional officials were preparing contests for the creation of their fragments of the Uniform State Health Information System, but in January 2012 a letter from Moscow almost blocked this work. Georgy Lebedev, deputy director of the Central Research Institute for the Organization and Informatization of Health Care (TsNIIOIZ), wrote to the regions that competitions should be held only after receiving an expert opinion from the Ministry of Health on technical tasks. The ministry was forced to refute this and urge officials to continue preparing tenders.

Concept of Uniform State Health Information System and financing approved

The concept of creating a Unified State Information System in Healthcare, which became the basic document of informatization, was approved by order of Minister Tatyana Golikova in April 2011.

Funds for modernization, including IT, are allocated from the budget of the Federal and Territorial Compulsory Health Insurance Funds (MHIF). In January 2013, Minister of Health Veronika Skvortsova reported that 20.2 billion rubles were provided for informatization in 2011-2012. from the FFOMS and 9.2 billion rubles. from the budgets of the subjects. Another 4.9 billion rubles. The Ministry of Health directed the creation and implementation of federal applied components of the Uniform State Health Information System.

Oleg Simakov calls Vladimir Zelensky the ideologists of the concept of the system (from 2007 to 2012 he worked as director of the department for the development of health insurance funds, then moved to the Ministry of Finance) and Roman Ivakin (from 2008 to 2012 - deputy director of the IT department, today - director of the IT department). In addition to Simakov, Ivakin and Zelensky, the document was directly developed by the Center for Information Technologies and Systems of Executive Authorities - CITiS, as well as a consortium of co-executors.

"In the course of this work, among other things, the general financial parameters of creating the system were determined," says Simakov. "In 2009 prices, it was approximately 96 billion rubles."

Thus, the funds allocated for 2011-2012 cover no more than a third of the costs of creating the system.

2008: Creation of a department in the Ministry of Health to coordinate informatization

"The creation of conceptual documents to determine the appearance of an interdepartmental system covering both the healthcare industry as a whole and extra-budgetary funds coordinated by the Ministry of Health were hindered by objective and subjective factors," said Oleg Simakov, Chief information officer of the RAMS Medical Information and Analytical Center, who headed the IT Department of the Ministry of Health and Social Development in 2008-2010^[37]. "As an objective factor, I can name at least the fact that in the recent history of Russia until 2008, the creation of an information system in health care was not centrally financed, the subjects did something on enthusiasm, and something the federation did in the form of separate works on nosological registers."

In mid-2008, the structure of the ministry was changed, and on the basis of two departments (information and analytical and technical support) they created a department that was supposed to form and coordinate the ministry's policy in the field of informatization. The priority was to provide information collection and processing tools for operational management of the most demanded tasks in health management activities.

The IT Department, together with the Ministry of Telecom and Mass Communications, has developed a draft order of the Government of the Russian Federation "On measures to create a state information system for personalized registration of medical care." It was supposed to allocate about 14 billion rubles for the creation of the system for 3 years, but due to the crisis, funding was reduced, and the processes for coordinating documents dragged on for more than 2 years.

"Only then, when working out the idea of ​ ​ health modernization programs, it was possible to justify the need for ICT work and 5% of the budget of modernization programs appeared, or 24 billion rubles," Oleg Simakov recalled.

1960-2007: Prerequisites for the creation of the Uniform State Health Information System

The history of informatization of health care in Russia dates back to the 1960s. The first developments of medical information systems (MIS) were then carried out in Moscow, Novosibirsk, Kemerovo, Novokuznetsk, Leningrad and were of an initiative nature.

Since 1975, in accordance with the decree of the Council of Ministers of the USSR on the creation of an automated control system (ACS) "Russia," the creation of specialized IT structures began in the system of research organizations of the USSR Ministry of Health. The department of control systems and computer technology appeared, the Scientific Council for the Coordination of Research and Development and Development in the field of health informatization was established, the republican information and computing center of the Ministry of Health was launched.

By 1980, the most advanced medical institutions already boasted a fairly large-scale use of IT systems.

"The generally accepted

methodology for the development of medical ACS does not yet exist, as the ACS themselves practically do not exist. Therefore, in our work, we used primarily our own experience based on the development and construction of 11 autonomous MIS, implemented at one time on the Minsk-23 computer, - said in his report in 1980 a representative of the Institute of Cardiovascular Surgery named after Bakulev V. E. Porfiryev. - These MIS - Automated Archive, Specialized Rheographic Information System, Information System "Ischemic Heart Disease," IS "Institute Personnel," IS Financial Calculations and others - allowed us to solve a wide class of medical problems. "

The Institute went further and thought about building a full-fledged ACS.

"A look into the past indicates that the tasks of most of the created medical information systems were either the use of computer technology in a limited aspect of medical care procedures, or the solution of purely economic problems," Porfiriev noted.

The institute decided that it is necessary to start with the creation of a system for managing the medical and diagnostic process. This system was supposed to collect and process patient data, providing collective access to them, form disease histories in an automated mode, provide personnel management, provide access to directories, perform accounting functions, etc.

Looking ahead, it is worth noting that the advanced ideas of the developers of the ISSH named after Bakulev 30 years later almost literally migrated to the concept of creating a Unified State Information System in the field of health care in Russia. "Most of the computer equipment is used to ensure the administrative and economic activities of medical organizations, while less than 20% of the computer fleet is used to automate the actual medical and diagnostic process," said the document approved by the order of the head of the Ministry of Health and Social Development Tatyana Golikova in 2011.

Throughout the 1980s, the country continued to develop a network of information and computing centers and departments of the ACS, the number of which increased from 47 in 1985 to 82 in 1990. "By this time, health care in only 10 territories did not have independent units of the information and computing service," the concept of informatization of health care said, developed in 1991.

At the same time, the computer fleet was increasing: in 1981-1985, 237 computers were purchased, and in the next five-year plan already 1837 (for comparison: in 2011-2012, 279.7 thousand units of computer equipment were already purchased from federal budget subsidies in the constituent entities of Russia). Software development was carried out: 153 systems, subsystems and a set of tasks were registered in the republican fund of algorithms and programs, the number of programs in operation increased from 900 in 1985 to 1110 in 1990. But, despite the positive dynamics, the authors of the 1991 concept stated a tendency "to allocate information support into independent systems that are not methodologically related to each other."

"The expanding possibilities of purchasing and introducing personal computers have made it possible to use computing equipment at the level of healthcare institutions in the territories. At the same time, there is no widespread industrial development, the understanding of theoretical and equipment with practical achievements is carried out by individual teams sporadically; the works are not coordinated, are haphazard, the document said. - Allocated material and labor resources are used irrationally. Low wages in IVC and ACS departments in healthcare compared to other industries and cooperatives lead to a shortage of qualified personnel in information and computing services. Significant difficulties arise due to the general computer illiteracy of the population and medical workers... Domestic computers do not meet modern requirements for their technical capabilities and are unstable in operation, there is no peripheral and network equipment, healthcare is not provided with hardware. "

Having analyzed the current situation taking into account the political factors associated with the collapse of the USSR, the authors of the concept stated "the absence in the next 10 years of economic, personnel, organizational, legal and technical opportunities for the implementation of the program of total informatization of healthcare," stating the need to strengthen state support for priority areas of research and development work, "allowing beyond 2000 to implement genuine informatization of healthcare."

The authors proclaimed the goal of their document the need to "outline ways of preparing for total informatization, determine the priority of tasks and projects, the solution and implementation of which should have a significant social and economic effect at minimal costs." It must be admitted that the "minimum cost" policy on health informatization was indeed implemented, but not for 10 years, as expected, but 2 times longer.

Information technologies in the social sphere

Separate article - Information technologies in the social sphere

Notes